Registered Nurse Clinical Quality Auditor
Company: Blue Shield of California
Location: Rancho Cordova
Posted on: June 1, 2021
Clinical Auditor/Coach will specialize in auditing and
performance improvement for Medical Management Nurses (Case
Managers, Utilization Managers or Post Service). Candidate will
develop performance metrics and evaluate performance to ensure that
continuous improvement of skills and knowledge required to be
successful in various nursing roles in Medical Management. The
Clinical Auditor/Coach adheres to California Continuing Education
Provider requirements and URAC, NCQA and DMHC training standards.
Ensures RNs are current on regulations through training provided in
classroom setting, one-to-one, intranet and through competency
training. Often acts as a resource resolving complex case issues or
interpretation of department protocols and procedures.
- Performs audits and provides developmental coaching for
- Provides clinical coaching and support to all staff to improve
skills and competencies required to successfully perform work.
- Designs, implements, evaluates and improves audit criteria and
training courses/programs to meet clinical needs of Medical
- May independently represent the training department in Medical
Management work re-design, process changes and software
- Conducts/facilitates effective presentations relating to
Medical Management processes and/or training for internal or
- Acts as a resource for the training and auditing team.
Knowledge, Education, and Experience
- Ability to provide direction and support to staff.
- Current California RN license. At least 4 years training and/or
auditing experience and at least 1 year experience in managed care
or similar complex healthcare environment.
- Bachelors or advanced degree preferred.
- Certified Case Manager (CCM ) &/or Certified Professional
in Learning and Performance (CPLP) preferred.
- Demonstrated skill with coordination of complex training
requests and large classroom environments.
- Meets or exceeds Sr. minimum experience requirements.
- Familiarity of Motivational Interviewing theory and
- Strong organizational and/or project management skills to
coordinate departmental projects & to perform multiple projects or
- Functions independently in classroom environment and lifecycle
- Subject matter expert w/capability to effectively train/audit
all lines of business and 8 of the 10 clinical processes.
- Current California RN license & 7 years related experience
and/or training, or equivalent combination.
- CCM, IQCI, CPLP preferred.
- QA and regular performance audits.
- Training and mentoring.
- About Company: At Blue Shield of California we are parents,
leader, students, visionaries, heroes, and providers. Everyday we
come together striving to fulfill our mission, to ensure all
Californians have access to high-quality health care at a
sustainably affordable price. For more than 80 years, Blue Shield
of California has been dedicated to transforming health care by
making it more accessible, cost-effective, and customer-centric. We
are a not-for-profit, independent member of the Blue Cross Blue
Shield Association with 6,800 employees, more than $20 billion in
annual revenue and 4.3 million members. The company has contributed
more than $500 million to Blue Shield of California Foundation
since 2002 to have a positive impact on California communities.
Blue Shield of California is headquartered in Oakland, California
with 18 additional locations including Sacramento, Los Angeles, and
San Diego. We're excited to share Blue Shield of California has
received awards and recognition for - LGBT diversity, quality
improvement, most influential women in corporate America, Bay
Area's top companies in volunteering & giving, and one of the
world's most ethical companies. Here at Blue Shield of California,
we're striving to make a positive change across our industry and
the communities we live in - Join us!
- Physical Requirements:
Office Environment - roles involving part to full time schedule
in Office Environment. Based in our physical offices and work from
home office/deskwork - Activity level: Sedentary, frequency most of
Please click here for further physical requirement detail.
- EEO Footer: External hires must pass a background check/drug
screen. Qualified applicants with arrest records and/or conviction
records will be considered for employment in a manner consistent
with Federal, State and local laws, including but not limited to
the San Francisco Fair Chance Ordinance. All qualified applicants
will receive consideration for employment without regards to race,
color, religion, sex, national origin, sexual orientation, gender
identity, protected veteran status or disability status and any
other classification protected by Federal, State and local
- Requisition ID: 210014P
- Posting Date: Mar 24, 2021
- Schedule: Full-time
Keywords: Blue Shield of California, Rancho Cordova , Registered Nurse Clinical Quality Auditor, Other , Rancho Cordova, California
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